Telemedicine This term refers to a live real-time, patient and provider interaction. This method of telemedicine takes advantage of encrypted videoconferencing as its core technology. The patient and provider are able to interact similar to a traditional clinic encounter. Synchronous telemedicine visits utilize a high-resolution video camera coupled with broadband technologies. Videoconferencing systems must use HIPAA-compliant encryption software, and work optimally with a connection speed of at least 384 kbps in both the downlink and uplink directions [16]. With the near-ubiquitous access to broadband technologies, the access to synchronous telemedicine is increasing while reducing cost as a barrier. The resolution for telemedical encounters must at the very minimum be 640 × 360 with a speed of 30 frames per second [16]. However, for diagnostic images a higher resolution is needed; a minimum resolution of 800 × 600 pixels (480 000) is required, but higher-resolution images may increase diagnostic fidelity. To ensure patient confidentiality, HIPAA requires 128-bit encryption and password-level authentication [17]. The minimum technical standards for conducting a synchronous telemedicine visit may vary on a case-by-case basis. For example, the American Telemedicine Association (ATA) acknowledges that lower bandwidth and resolution may be appropriate for telepsychiatry evaluations [18], but recommends a much higher image resolution for visits that rely more heavily on images and physical examination findings to make diagnostic and therapeutic choices. According to ATA guidelines, teledermatology equipment should display images in at least 75 pixels per inch (ppi) with spatial resolution at a minimum of full Common Intermediate Format (CIF)—and a preferred minimum of 2 CIF—a minimum of 0.19-dot pitch monitor for resolution, a minimum of 0.5 candelas per square meter (cd/m2 ) of luminance, and a contrast ratio of at least 1:500 [19]. Each clinic, and provider, should strive to provide high-quality resolution at both the distant and originating sites. Asynchronous Telemedicine Also called “store-and-forward,” this term refers to a method of providing consultations to referring providers or patients without a live audio or video interaction with the patient or referring physician. Clinical data, such as a chief complaint, history of present illness, pertinent medical and family histories, medication list, allergies, description of examination findings, photographs of examination findings, laboratory values, culture data, and radiographic studies are digitally provided to the ID consultant, reviewed in depth, integrated, and used to formulate an expert opinion regarding a specific case. The most common specialties to use asynchronous telemedicine include dermatology and radiology, where much of the clinical evaluation relies on reviewing high-definition images rather than a real-time interaction or physical examination provided by the specialist at the distant site, but may be used for Downloaded from https://academic.oup.com/cid/article/64/3/237/2912592 by guest on 03 December 2021 IDSA Position Statement on Telehealth and Telemedicine • CID 2017:64 (1 February) • 239 ID consultation in specific cases and clinical questions. After reviewing clinical data, the ID physician provides a timely consultative report back to the referring provider or patient at the originating site. Asynchronous (store-and-forward) ID telemedicine services may be one of several different types of interactions: 1. Teletriage involves the review of patient cases transmitted by a referring provider to determine which patients need to be seen in-person by an ID physician, which patients can be cared for by teleconsultation, and which patients may not need a referral. 2. Teleconsultation involves the review of patient cases transmitted by a referring provider and the provision of a consultative report back to the referring provider. Unless the patient’s care is then transferred to the consulting ID physician, the referring provider typically maintains responsibility for carrying out treatment recommendations. 3. Direct-to-patient telemedicine involves a patient originating his/her own consultation by transmitting a